Active NPI
Dianne Mitchell, PH.D.
- Psychologist
- Winston Salem, NC
National Provider Identifier
1225248461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 966
- Practice address
- 121 Reynolda VLG
Suite G
Winston Salem, NC 27106-5126 - Phone
- (336) 761-8600
- NPI assigned
- May 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 966 | NC | Primary |
Addresses
Primary practice location
121 Reynolda VLG
Suite G
Winston Salem, NC 27106-5126
Mailing address
121 Reynolda VLG
Suite G
Winston Salem, NC 27106-5126
Phone (336) 761-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04143 | Other | NC | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 966 | NC | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dianne Mitchell, PH.D., PLLC | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Winston Salem, NC
- NPI 1548470776
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286496000000",
"number": "1225248461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 REYNOLDA VLG",
"address_2": "SUITE G",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271065126",
"telephone_number": "336-761-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 REYNOLDA VLG",
"address_2": "SUITE G",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271065126",
"telephone_number": "336-761-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "DIANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-23",
"last_updated": "2010-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "966",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF NORTH CAROLINA",
"identifier": "04143",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.